Volume 18, Issue 1 | 2010

The Careful Decision to

Bedshare Helping Parents Navigate Choices About Infant Sleep Location PAGE 8

Recommended Readings PAGE 18 PLUS

DONA Remembers PAGE 27

Quarterly publication of

16th Annual

DONA International Conference August 5-8, 2010 Albuquerque, New Mexico

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Volunteer on the

BOARD OF DIRECTORS! s #ONFERENCE $IRECTOR s -EXICO $IRECTOR s .ORTHEASTERN 53 $IRECTOR Find requirements and application procedures for all open positions at www.DONA.org

TEAM PLAYER? You could be a

PUBLISHED author… artist… photographer Submit your feature articles, research, poems, book or video reviews, doula doings, questions for Penny, letters to the editor and photos or artwork.

Email [email protected] for detailed information 2 International Doula

Volume 18, Issue 1

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Join the DONA Publications Committee as an International Doula Associate Editor

Various editorial positions in English, Spanish and French are available for you to consider! For more details, contact [email protected]

CONTENTS Features 7 8 14

22

15 16 18

Not On Call The Careful Decision to Bedshare Birth as I Know It— ! $OULAgS *OURNEY ON -AUI A Father's Perspective on Doulas The Lullaby of Love Read This, Not That

Departments

18

6 21 28 28 33

Book Review—Understanding the Dangers of Cesarean Birth Tricks of the Trade— -EET THE "ACKUP $OULA Poem—Forty Weeks and a Day Quotes Capturing the Doula Spirit

Columns 4   24 25 29

Letter from the President ,ETTER FROM THE -ANAGING %DITOR %SSAYˆ! $OULAgS %XPERIENCE IN !FRICA Essay—The Postpartum Doula Essay—Pre-Birth Butterflies Ask Penny—Who and Where are Tomorrow's Leaders?

Member News & Benefits

15

27 27

Postcard from Home Departed Doula

Forms 

-EMBERSHIP  #ERTIFICATION

Cover reads

www.DONA.org 3

FROM THE PRESIDENT

A

Dear DONA Members,

BOARD OF DIRECTORS President

353!. 4/&&/,/.

President Elect

new year. A time to evaluate and reflect on our lives—our goals, our dreams, our “to do” lists, and to readjust, realign, or bask in the satisfaction of a course well set, well traveled, and with the ultimate destination still in our sight. In January, DONA International’s board of directors met for its annual interim meeting. These interim meetings afford a great time for the board to evaluate and reflect on DONA International’s “life” and the feedback from our members. DONA International’s goals, dreams, and “to do” list is ever strengthening and growing. We are so excited about the many new projects and plans that lie ahead for DONA members and for our certification programs. Doulas are becoming a household word; from local broadcasts to CNN, from sitcoms to major Hollywood productions, doulas are being mainstreamed. That’s the good news. This good news can have a flip side. Often, anything that is not the old “status quo” will be challenged (in my opinion, especially in health care). Doulas’ services are being challenged around the globe. DONA International’s vision of a doula for every woman who wants one is being challenged. Thankfully, at this moment this challenge is in relatively few areas; however, to stay true to our vision and help birthing women, just one area of challenge is too many as these sorts of challenges can grow like a cancer. DONA International is working on ways to help with these issues and assist our members serving birthing families. DONA members have the best tools in the business to mediate these issues: the DONA International Standards of Practice and Code of Ethics. Often, challenges and clashes occur because there is a misunderstanding and mistrust of the doula’s role. As a DONA member, you can use those documents to effectively bridge communication gaps to explain clearly who a DONA doula is and what s/he does. When you became a member, you agreed to abide by them. Follow them—do not deviate from them. They are very clear and concise and can and should be applied to any and all situations. When you practice within these guidelines, you have an “upper hand” to present a strong raison d’être to the “powers that be” to mitigate those misunderstandings. A quote from Penny Simkin, one of DONA International’s esteemed founders, is a wonderful way to sum this up as you go forward into the new year and work on challenges to doulas—“Build bridges, not fences.” As DONA members, we should live it, breathe it, and most of all believe in it. Warmly,

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Treasurer

KIRSTEN ROHL

Director of Education !.. '2!5%2

Director of Certification 54! -!44/8

Director of Publications 35.$!9 4/24%,,)

Conference Director OPEN

Director of Int’l Development NICOLE HEIDBREDER

Director of Membership Support 9!.! +!4:!0 .!#+-!.

Director of Public Relations 34%&!.)% !.45.%3

Multicultural Director

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REGIONAL DIRECTORS Northeastern US OPEN

Southeastern US 0!44) 42%5"%24

Midwestern US DANI JOHNSON

Southwestern US CINDY HODGES

Western Pacific US HEATHERGAIL LOVEJOY

Eastern Canada *5,)! -ACNEIL

Western Canada SHERI DEVENEY

Mexico OPEN

FOUNDERS ANNIE KENNEDY · JOHN KENNELL -!23(!,, +,!53 q 0(9,,)3 +,!53 0%..9 3)-+).

INTERNATIONAL DOULA TEAM Director of Publications 35.$!9 4/24%,,) 05",)#!4)/.3 $/.!/2'

Managing Editor

,/2%% 3)%2-!#(%3+9 )$%$)4/2 $/.!/2' 0/ "/8  *!30%2 ). 

Associate Editor TANYA HALVORSEN

Please send all contributions to the editor

DESIGN WISE GROUP

NATASHA FLETCHER, Art Director www.wisegroup.com

4 International Doula

Volume 18, Issue 1

FROM THE MANAGING EDITOR

N

Dear DONA Members / Chers Membres de DONA,

ature often holds up a mirror so we can see more clearly the ongoing processes of growth, renewal and transformation in our lives. Spring is always my favorite time of the year as life awakens from a long winter’s nap and the future is bright with possibilities. Depending on where you live, you may already be seeing some telltale signs of the new season—migratory birds returning, trees beginning to bud or crocuses peeking through the last of winter’s snow—at least those of us in the Northern Hemisphere! Spring is the time for new beginnings. I find myself reprioritizing my goals, clearing out the proverbial cobwebs and seeing the world with a fresh pair of eyes. I cannot wait to get a handle on what this year will bring—knowledge, education and of course…new little ones. I also continue to grow in my role as managing editor and am thrilled to introduce to the International Doula team, our associate editor Tanya Halvorsen, a DONA trained birth doula from Stratford, Ontario. This issue would not have come together without her humorous input, her passion for the written word and her steadfast ability to make even the tightest deadline. Welcome Tanya! But without your support, this issue would not have come together at all. We are eager to accept your articles, poems, reviews and photos. You are always welcome to contact me with your submissions at [email protected]. Don’t forget that you can also receive four alternative continuing education credits for each contribution that is published up to a maximum of eight credits. What a simple and affordable way to earn recertification!

Souvent, la Nature nous offre le reflet de notre propre vie afin de nous montrer plus clairement les processus constants de changement, de renouveau et de transformation qui nous animent. Le Printemps est toujours ma saison préférée: la vie se réveille d’une longue sieste hivernale et l’avenir est riche en possibilités. Selon là ou vous habitez, vous pouvez peut être d’ors et déjà voir des signes révélateurs du changement de saison- le retour des oiseaux migrateurs, des arbres en bourgeon ou des crocus perçant les derniers restes des neiges de cet hivers- du moins, celles de vous qui habitez dans l’Hémisphère Nord! Le Printemps est la saison des nouveaux commencements. C’est le moment ou je réorganise mes objectifs par priorité, ou j’abandonne ce qui me pèse et ou je redécouvre le monde avec un regard neuf. J’ai hâte que se révèle ce que cette année nous apportera : connaissances, éducation, et bien entendu…de nouveaux petits bout de choux! Je continue également à m’épanouir dans mon rôle de Rédacteur en Chef et je suis ravie de présenter notre Rédacteur Associée à l’équipe de Doula Internationale: Tanya Halvorsen, doula formée par DONA et originaire de Stratford, Ontario. Cette édition ne se serait pas faite sans son apport plein d’humour, sa passion pour l’écriture et son aptitude tenace à respecter les plus stricts délais. Bienvenue Tanya! Mais sans votre soutien, ce numéro n’aurait pas vu le jour du tout. C’est avec enthousiasme que nous attendons vos articles, poèmes, critiques et photos. Vous êtes toujours les biens venues à me soumettre vos propositions à l’adresse suivante: [email protected]. N’oubliez pas que chacune de vos publications vous permet également de valider quatre unités de valeur pour votre formation en continue, et ce jusque huit unités de valeur. Quelle façon simple et abordable d’acquérir sa recertification!

www.DONA.org 5

BOOK REVIEW

Understanding the Dangers of Cesarean Birth: Making Informed Decisions By Sunday Tortelli, CCE, CD(DONA), HBCE, LCCE, CLC

I

confess; I am tired of reading the influx of new literature bemoaning the continually increasing cesarean rate while simultaneously reading the exhaustive amount of medical research challenging this issue. Something just is not connecting. It is not that we do not know that the cesarean rate has climbed obscenely high. It is not that there isn’t an abundance of research proclaiming that birth is and should be, well, normal. There just seems to be this drive, propagated

IT IS WELL RESEARCHED, WELL DESIGNED AND WELL WRITTEN

6 International Doula

by mainstream medicine, to contradict nature and, absurdly, even sound scientific research. What is going on? Alas, there is this new book to read. It accomplishes what it set out to do…inform, educate, contradict and even pressure women into taking back birth. It is well researched, well designed and well written. The stats and facts are current, which is important if we are going to recommend it to women (and professionals) as a resource, as there is nothing worse than a woman approaching her doctor with the intention toward normal birth or VBAC with outdated stats as her ammunition. What can you expect to find in this book? Confirmation of what you mostly already believe and know, but that is not a bad thing. “Cesarean section is the most common major surgical procedure performed in the United States” says the first page, second paragraph of the Introduction. The first page, second paragraph of chapter 1 states, “…only 23 percent of all obstetric practice recommendations issued by the organization [ACOG] are category Level A; that is, based on good and consistent scientific evidence.” Surprised? I doubt it. So it goes for quite a while. The author takes her time explaining in a very detailed way about hospital policies and policy makers, evidence based care practices in the U.S. and other countries, informed or ill-informed consent, and the deal with supposed patient-choice cesareans. She explains the differences between elective and emergency cesareans, including reasons for them, how they are done and the risks to mother, baby and future pregnancies associated with either variety. Prolonged labor (dystocia, FTP, CPD) is obviously over diagnosed, which we knew way back when the 1988 Public Citizen’s Health Research Group

Volume 18, Issue 1

found that between 1980 and 1985 these diagnoses increased by 42 percent! She compares the risks of planned VBAC and repeat cesarean, reminding us that the overall risk of uterine rupture is less than one percent, “the same risk as for any woman giving birth the first time.” Despite this fact, nine out of ten women had a repeat cesarean in 2005 due to the fear of uterine rupture coupled with the fear of litigation and malpractice insurance woes—hardly rational reasons. The last few chapters of the book go into more detail about what a woman can do to experience a normal birth. Childbirth education and preparation, finding alternatives to cesarean in situations such as a breech presentation, avoiding unnecessary interventions, and all the typical common sense approaches are encouraged. Midwifery care is highlighted as is out-of-hospital birth as means to a satisfactory end. Each chapter concludes with a summary entitled, “Especially for Mothers,” some end with a section addressed to the partners and all include a resource list. Overall, this is a worthwhile and timely book, filled with important advice and valuable information. I just think it is too bad that we needed another one. Sunday Tortelli is a certified childbirth educator, certified lactation counselor, DONA certified doula, DONA trained postpartum doula and DONA approved birth doula trainer in the Cleveland, Ohio area. Sunday also serves as the DONA Director of Publications. She is the mother of four grown children.

Understanding the Dangers of Cesarean Birth: Making Informed Decisions Written by Nicette Jukelevics Westport, CT: Praeger, 2008

Feature Story

Not On Call! By Dorothy Haines, CD(DONA), LCCE

L

ast night I was up until 2:30 a.m. reading and it was a wonderful, wonderful thing. It is not something I can indulge in too often because, more often than not, I am…on call. What does that mean? That means that one of my doula clients is within two weeks of her due date and there is a possibility that I could be called to a birth— at any time. So I need to be ready—all the time! First, I need to make sure my doula bag is packed and ready to go. Camera battery and iPod are charged. Extra batteries are available. Everything is cleaned and sanitized from the last birth I attended. Then, for every day that I am on call, I need to make sure that I have: © bw‰ŠCƒ„‹Š{ y~‚zywˆ{ wŒw‚wx‚{ © i…ƒ{…„{ Š… Šˆw„‰†…ˆŠ ƒ y~‚zˆ{„ Š… activities if needed © i…ƒ{Š~„} {w‰ „ Š~{ |ˆ{{{ˆ Š~wŠ ƒ teens or husband can cook or heat up for dinner

A doula’s lifestyle Then I think through my plans for the day. I need to make sure that I am not straying too far from home—if a client calls me, I need to be able to get there within a reasonable amount of time. Any appointments, meetings, plans, play dates, etc. need to be made with the caveat that, “I might get called to a birth and need to cancel.” If there is a birthday or holiday when I am on call, there is always the possibility that I will miss it because I am at a birth. My birth supplies and birth ball live in the back of my van. If my husband wants to take my van anywhere, he needs to make sure to take out my supplies. I do not drink alcohol when I am on call because I never know when someone might go into labor.

I cannot take sleeping pills of any kind either. The hardest part for me is making sure I get to bed at a decent hour. It is a bad, bad thing to stay up until 2:00 a.m. with a book I just cannot put down and then get a phone call at 2:30 a.m. that someone is in labor and I need to leave and possibly not be back for 24 plus hours. Last summer, I had a lot of births. I was on call constantly since early June. Our family went away in the middle of June making sure we did not go very far. We took two cars knowing I might have to come back for a birth. I did. But now, my final August client had her baby last week. My mid-September client already had her baby and my late September client is a couple of weeks away from needing me. So in the meantime I am staying up late and drinking wine and making plans that I know I probably will not have to change. In two weeks, I will be on call again and that is okay. If I were away much longer than that, I would be itching to get back. For now, I am so much enjoying the noton-call life! Dorothy Haines, CD(DONA), LCCE has been a certified birth doula since 2004 and a certified Lamaze educator since 2007 and works with couples throughout Central New Jersey. Dorothy is married and has five children, ranging in age from 8 to 21. She will remember 2009 as the year in which she had her 100th birth as a doula.

I might get called

to a birth and need to cancel

www.DONA.org 7

Cover Story

The decision to bedshare is an

intimate, family choice that must

be made with proper intention and education to ensure maximum infant protection 8 International Doula

Volume 18, Issue 1

Bedshare

The Careful Decision to

Helping Parents Navigate Choices about Infant Sleep Location By Lee T. Gettler, MA1, 2

P

ostpartum educators and health professionals working with parents to help prepare them for providing care to their infants are often faced with conflicting recommendations as to how they should advise new parents, especially when it comes to prescriptions regarding infant sleep location and what constitutes “safe infant sleep.” Controversies surrounding bedsharing frequently take center stage in this debate (see McKenna and McDade 2005). Although various forms of cosleeping are accepted as common and safe practices in cultures around the world (Barry and Paxson 1971) and nearly half of all breastfeeding mothers in the United States and Great Britain frequently, if not routinely, bring their baby to sleep with them for some or all of the night (Ball 2002; Blair and Ball 2004; Lahr et al. 2005; Willinger et al. 2003), bedsharing is a highly contentious practice that draws quick condemnation from many medical and public health authorities. For example, the American Academy of Pediatrics (AAP) specifically recommends against bedsharing, but supports “roomsharing,” another form of co-sleeping in which mothers and infants sleep in close proximity but not on the same sleeping surface (AAP 2005). Yet, epidemiological studies reveal inconsistent findings as to whether or not, to what degree, or under what circumstances bedsharing represents a risk factor for Sudden Infant Death Syndrome (SIDS) and/or unexpected infant death (SUID). Although studies are plagued by inconsistent definitions of bedsharing (e.g. categorizing deaths on sofas or recliners as bedsharing deaths) and details of the

circumstances within which infants die, several studies have shown heightened risks for infants when sleeping with an adult (Carroll-Pankhurst and Mortimer 2001; Scheers et al. 2003; Tappin et al. 2005), whereas studies including appropriate covariates and confounders have shown slightly elevated (Carpenter et al. 2004; McGarvey et al. 2006) or no difference (Blair et al. 1999) in risk for bedsharing infants of breastfeeding, nonsmoking mothers.

Definition of co-sleeping Clarity and consistency in defining the various forms of co-sleeping, including bedsharing, are absolutely critical if we are ever to achieve a level of understanding of this complex and heterogeneous behavior that will serve to produce appropriate and helpful public health recommendations. For example, although they are not identical in form or function, “cosleeping” and “bedsharing” are often used interchangeably. According to McKenna et al. (1993), “co-sleeping” should be used as an umbrella term, in need of further taxonomic distinctions, characterized by any sleeping arrangement in which an infant and his/her caregiver sleep in close enough proximity to engage in and communicate through sensory exchanges. For instance, co-sleeping can include situations where an infant is placed in a crib or bassinet in the parents’ room or where an infant sleeps next to his/her mother on the parental bed. However, while co-sleeping requires proximity it does not necessarily denote the parent-infant dyad sharing the same sleeping surface. “Bedsharing” is a specific sub-category of

co-sleeping that requires the parent-infant dyad sleep on the same surface in an adult bed (McKenna et al. 2007). Although “bedsharing” is frequently treated as a singular category in the epidemiological and medical literature, it has been argued elsewhere (McKenna and McDade 2005) that in order to fully delineate the health implications of infant sleep location the safety of bedsharing must be viewed as a continuous variable that ranges from highly unsafe and potentially lethal to safe and potentially health promoting. Moreover, when helping parents navigate decisions related to bedsharing and infant sleep problems, postpartum professionals would be best served to acknowledge the distinction between what are sometimes referred to as “reactive bedsharers” and “routine or intentional bedsharers” (Keller and Goldberg 2004; Lozoff et al. 1984; Madansky and Edelbrock 1990; Ramos and Youngclarke 2003). Reactive bedsharers are characterized as families that intend to practice solitary infant sleep but who bring their infant into the parental bed, not necessarily because they want to sleep with their child, but as a means by which to ameliorate, for instance, child sleep difficulties and/or to ease nighttime feeds. Reactive bedsharers generally engage in bedsharing less frequently and for shorter periods of time on a given night. Conversely, routine or intentional bedsharers are families who prefer to have their infant in bed with them and choose to practice bedsharing on a regular, day-to-day basis. Routine bedsharers are more likely to have their infant in the adult bed for the entirety of the night. However, whether families practice reactive or routine bedsharing, it is crucial that families be aware of the many www.DONA.org 9

Cover Story safety precautions that should be instituted when doing so. Because infants in reactive bedsharing families spend significantly less time in the adult bed, their parents may not be acutely aware that even short periods of unsafe bedsharing are risk factors for potentially deleterious outcomes. Postpartum professionals should work to inform both routine and reactive bedsharers of the safest possible means of doing so (see below).

Safe bedsharing Unfortunately, unlike catch phrases that succinctly delineate the safe practice of certain positive parenting behaviors, such as “breast is best” or “back to sleep,” there is no simple way to communicate the safest possible way for families to practice bedsharing. Familial bedsharing is unlikely to be an advocacy centerpiece for any major public health campaigns in the near future, although UNICEF’s “baby friendly initiative” in the UK, for example, has a pamphlet for parents on safe bedsharing practices (UNICEF 2008). Nonetheless, the decision to bedshare is an intimate, family choice that must be made with proper intention and education to ensure maximum infant protection. The bedsharing environments in most western households ordinarily involve adult beds that are not designed to enhance (or account for) infant safety and thus they pose many potential risks to infants. Almost all of these risks are, however, easily avoidable. If postpartum professionals choose to recommend and/ or support bedsharing among the families they serve, it is imperative they ensure parents implement the following safety precautions (Gettler and McKenna 2009): ©

©

©

_| x{z‰~wˆ„} „y‚‹z{‰ Š… †wˆ{„Š‰B Š must be a mutual decision, with both parents (not just mother) agreeing to be vigilant and responsive to the infant. c…Š~{ˆ‰ ~… ‰ƒ…{ ‰~…‹‚z „{Œ{ˆ practice bedsharing but should opt for non-same surface co-sleeping (roomsharing). fwˆ{„Š‰ Š~ xwx{‰ x…ˆ„ ‰ƒw‚‚ for gestational age should avoid bedsharing.

10 International Doula

©

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\wƒ‚{‰ ~… y~……‰{ Š… x…ŠŠ‚{C|{{z (without breastfeeding) should be encouraged to practice roomsharing, not bedsharing. _| †wˆ{„Š‰ †‚w„ Š… x{z‰~wˆ{B „‰Šˆ‹yŠ them to remove their mattress and box spring from their bed, placing them in the center of the room away from all walls. Babies can become wedged in spaces between mattresses and walls, potentially leading to suffocation. _| †wˆ{„Š‰ y~……‰{ Š… {{† Š~{ x{z frame, they must eliminate spaces between the mattress and head- and footboards. The bed must always be kept away from adjacent furniture. In total, these measures prevent infants from becoming wedged between furniture items and the bed/mattress. e‚z{ˆ y~‚zˆ{„ w„z †{Š‰ ‰~…‹‚z „…Š sleep in the bed with an infant.

Parents should not bedshare when under the influence of drugs, alcohol or prescription medications inducing drowsiness or affecting arousal. Infants should not bedshare with unrelated adults, only with adults actively involved in day-to-day care and parenting. Bedsharing should be practiced on a firm mattress without duvets or heavy bedding. Infants should be kept away from pillows and other bedding items that could potentially obstruct infant breathing. Infants should not be left alone to sleep on an adult bed. Co-sleeping should never be practiced on a sofa, recliner or chair. Never bedshare on a waterbed.

Breastfeeding Although bedsharing remains a controversial practice, many scientists have shown that there are benefits related to mother-infant bedsharing under safe conditions. In particular, routine, safe bedsharing is associated with significantly higher breastfeeding rates, including greater number of feeds per night, longer duration per feed and, resultantly, significantly greater total feeding time per night (reviewed in McKenna et al. 2007). In a randomized, non-blinded trial, Ball and colleagues showed that mother-infant

Volume 18, Issue 1

sleep proximity and consequent ease of access to breastfeeding led to higher suckling frequency on the postnatal ward (Ball et al. 2006). Since early postnatal suckling frequency is an important determinant of breastfeeding initiation at hospital discharge and consequent maintenance of breastfeeding, it is unsurprising that mother-infant pairs assigned to sleep in close proximity showed greater breastfeeding and exclusive breastfeeding rates at two, four, eight and sixteen weeks postpartum (Ball and Klingaman 2008). On top of the many, well-described immunological and developmental benefits known to result from breastfeeding (Hale and Hartmann 2007), it is now known that breastfeeding is also an independently protective factor against SIDS (Vennemann et al. 2009). Moreover, mothers who breastfeed experience resultant health benefits, such as reduced risk of developing breast cancer (Beral et al. 2002). Overall, these results indicate the potential role of bedsharing and mother-infant proximity in facilitating feeding practices that promote both maternal and infant long-term health.

Sleep patterns With regards to sleep patterns, infants awake more frequently but for significantly shorter periods of time compared to solitary sleeping mothers and infants, suggesting that mothers choosing to routinely bedshare (and breastfeed) do not habituate to the presence of their infant in terms of arousal. Rather, routine bedsharing with breastfeeding leads to synchronization between mother and infant in terms of arousals and sleep stage shifts (McKenna and Mosko 1994). Furthermore, despite more frequent arousals, bedsharing, breastfeeding mothers and infants show significantly greater sleep duration compared to when they sleep separately (McKenna et al. 2007). In general, exclusive breastfeeding at three months is associated with significantly greater sleep for both mothers and fathers (Doan et al. 2007). However, likely as a result of more frequent arousals, bedsharing infants

Long-term effects

There is no simple way to communicate the

safest possible way for families to practice bedsharing

also spend significantly less time in deep sleep (stages 3-4) over the course of the night than do routinely solitary sleeping infants. Young, neurologically developing infants are most likely to experience central apneas and difficulty arousing when in deeper sleep (stages 3-4) (Mosko et al. 1996; Richard et al. 1998). Thus, it has been argued elsewhere that less deep sleep combined with more frequent arousals in lighter sleep (stages 1-2) may prove particularly protective to infants with developmentally or congenitally-based arousal deficiencies (McKenna et al. 1993; Mosko et al. 1997a), which may be a primary factor in some SIDS cases (Byard and Krous 2003; Krous et al. 2004); however, these hypotheses await testing. Moreover, perhaps contrary to expectations, bedsharing mother-infant dyads sleep more than their solitary sleeping counterparts and, in fact, routinely bedsharing mothers report greater satisfaction with their sleep (Mosko et al. 1997b). Routine bedsharing has also been shown to have no effect on maternal reports of marital satisfaction (Germo et al. 2007; Messmer 2009), whereas reactive bedsharing mothers showed a significant negative association between time spent bedsharing and marital satisfaction (Messmer 2009). These results suggest that, for two parent households, the decision to

bedshare should be made jointly in order to maximize emotional and psychological well-being for parents and infants alike. While cultural shifts in many western societies over the last few hundred years have led to the widespread belief that solitary infant sleep is normative (see McKenna et al. 2007), human infants and their Hominin and primate ancestors have evolved to sleep in close proximity to their caregivers. In other words, mother-infant nighttime proximity and its associated sleep profiles are evolved, adapted norms, not dangerous anomalies (McKenna et al. 2007). The assumption that familial bedsharing is pathological is akin to the logical error Dr. George C. Williams dubbed “the fallacy of medical normalcy” and what Dr. Andrea Wiley refers to as “bio-ethnocentrism.” As Wiley states, “Both of these concepts refer to the tendency to consider as normal for Homo sapiens characteristics that are most common only in certain groups, especially Europeans” (p.117, Wiley 2008). While western cultural norms and medical practices are often assumed to be inherently best or superior and, in this case, healthiest, human infants are biologically designed to sleep close to their mothers, especially, and when doing so they will feed and wake more frequently as a natural and expectable outcome.

Although relatively few studies have assessed the long-term effects of bedsharing and/or co-sleeping on child development, much of the existing data indicate positive or neutral resultant outcomes. Children who co-slept early in life show lower physiological levels of stress in response to daycare in early childhood than do solitary sleepers (Waynforth 2007). Also, contrary to frequent assumptions about solitary sleep and child autonomy, early co-sleepers also show greater social (e.g. making friends) and functional (e.g. dressing oneself) independence than do solitary sleepers (Keller and Goldberg 2004). Moreover, children in military families practicing co-sleeping receive more positive behavioral ratings by their teachers and are under-represented in psychiatric care populations compared to solitary sleepers (Forbes et al. 1992). Yet, other data indicate that co-sleeping children take longer to routinely sleep through the night (Adams et al. 2004; Keller and Goldberg 2004; Touchette et al. 2005), which may prove problematic or cumbersome to certain families. An additional study found that bedsharing children are more prone to traits associated with “negative temperament” as pre-schoolers, based on parental reports (Hayes et al. 2001). However, this study failed to distinguish between routine and reactive bedsharing, a distinction that may have implications for their results. There are limited data available for longer-term implications of co-sleeping. However, college-age males who co-slept with their parents between birth and five years of age exhibit significantly higher self-esteem and experience less guilt and anxiety (Lewis and Janda 1988), while women who co-slept during childhood show less discomfort about physical contact and affection and have greater self-esteem in adulthood (Crawford 1994; Lewis and Janda 1988). Finally, in the largest study to date, involving more than 1,400 subjects, Mosenkis (1998) found that individuals who had co-slept as children reported a higher overall sense of satisfaction with their adult lives. www.DONA.org 11

Cover Story Conclusion

REFERENCES

In conclusion, bedsharing is a practice that feels natural and healthy to many parents, particularly those practicing breastfeeding. Breastfeeding and parentchild nighttime sleep proximity are tightly linked for evolutionary reasons that go back tens of millions of years. Thus, bedsharing is unlikely to be eradicated or eliminated altogether, particularly based on overly generalized public health recommendations or impersonal clinical consultation. For example, in a recent article on parental perspectives on bedsharing, Chianese and colleagues (2009) state, “Common to all groups was the finding that clinicians’ advice against bedsharing did not influence parents’ decision, but advice to increase safety when bedsharing would be appreciated” (p. 26). Recommendations regarding bedsharing cannot and should not be made in a wide sweeping, dichotomous “pro” or “con” fashion. Postpartum educators and health care providers must be attuned to the needs and contextual characteristics of each individual family as they assist them in making crucial parenting decisions, including where their infant should sleep. Only under these circumstances will the question of whether a family should bedshare or not be approached safely and respectfully, from a well-informed perspective, according to each family’s individual situation. Lee T. Gettler, MA is a doctoral student at Northwestern University in the Department of Anthropology and is the Associate Director of the Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, Department of Anthropology. He has co-authored multiple scholarly articles and book chapters on topics ranging from bedsharing and breastfeeding to the association between male testosterone levels and body composition. His dissertation research at Northwestern University will focus on the longitudinal neurohormonal changes human men experience as they transition to fatherhood and the potential implications of such shifts for paternal behavior.

AAP. 2005. American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome. The changing concept of Sudden Infant Death Syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 116(5):1245-1255. Adams SM, Jones DR, Esmail A, and Mitchell EA. 2004. What affects the age of first sleeping through the night? Journal of Paediatrics & Child Health 40:96-101. Ball H, and Klingaman K. 2008. Breastfeeding and mother-infant sleep proximity: Implications for infant care. In: Trevathan W, Smith EO, and McKenna JJ, editors. Evolutionary Medicine and Health: New perspectives. New York: Oxford University Press. Ball HL. 2002. Reasons to bed-share: why parents sleep with their infants. Journal of Reproductive and Infant Psychology 20(4):207-221. Ball HL, Ward-Platt MP, Heslop E, Leech SJ, and Brown KA. 2006. Randomised trial of infant sleep location on the postnatal ward. Arch Dis Child 91(12):1005-1010. Barry H, and Paxson LM. 1971. Infancy and early childhood: cross-cultural codes .2. Ethnology 10(4). Beral V, Bull D, Doll R, Peto R, Reeves G, La Vecchia C, Magnusson C, Miller T, Peterson B, Pike M and others. 2002. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 360(9328):187-195. Blair P, Fleming P, Bensley D, Smith I, Bacon C, Taylor E, Berry P, and Golding J. 1999. Where should babies sleep -- alone or with parents? Factors influencing the risk of SIDS in the CESDI Study. BMJ 319:1457-1462. Blair PS, and Ball HL. 2004. The prevalence and characteristics associated with parent-infant bedsharing in England. Arch Dis Child 89(12):11061110. Byard RW, and Krous HF. 2003. Sudden infant death syndrome: Overview and update. Pediatric and Developmental Pathology 6(2):112-127. Carpenter R, Irgens L, Blair P, and Fleming P. 2004. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 363:185. Carroll-Pankhurst C, and Mortimer E. 2001. Sudden infant death syndrome, bed-sharing, parental weight, and age at death. Pediatrics 107:530-536. Chianese J, Ploof D, Trovato C, and Chang J. 2009. Inner-city caregivers’ perspectives on bed sharing with their infants. Academic Pediatrics 9:26-32. Crawford M. 1994. Parenting practices in the Basque country: Implications of infant and childhood sleeping location for personality development. Ethos 22(1):42-82. Doan T, Gardiner A, Gay CL, and Lee KA. 2007. Breast-feeding increases sleep duration of new parents. J Perinat Neonatal Nurs 21(3):200-206.

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Forbes J, Weiss D, and Folen R. 1992. The co-sleeping habits of military children. Mil Med 157:196-200. Germo GR, Chang ES, Keller MA, and Goldberg WA. 2007. Child sleep arrangements and family life: Perspectives from mothers and fathers. Infant and Child Development 16:433-456. Gettler LT, and McKenna JJ. 2009 JanuaryFebruary. The science of sharing sleep. Mothering:42-51. Hale T, and Hartmann P, editors. 2007. Textbook of human lactation. Amarillo, TX: Hale Publishing. Hayes M, Parker K, Sallinen B, and Davare A. 2001. Bedsharing, temperament, and sleep disturbance in early childhood. Sleep 24(6):657-662. Keller MA, and Goldberg WA. 2004. Cosleeping: Help or hindrance for young children’s independence? Infant and Child Development 13(5):369-388. Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T, Cutz E, Hanzlick R, Keens TG, and Mitchell EA. 2004. Sudden infant death syndrome and unclassified sudden infant deaths: A definitional and diagnostic approach. Pediatrics 114(1):234-238. Lahr MB, Rosenberg KD, and Lapidus JA. 2005. Bedsharing and maternal smoking in a population-based survey of new mothers. Pediatrics 116(4):E530-E542. Lewis R, and Janda L. 1988. The relationship between adult sexual adjustment and childhood experience regarding exposure to nudity, sleeping in the parental bed, and parental attitudes toward sexuality. Arch Sex Behav 17:349-363. Lozoff B, Wolf A, and Davis N. 1984. Cosleeping in urban families with young children in the United States. Pediatrics 74:171-182. Madansky D, and Edelbrock C. 1990. Co-sleeping in a community sample of 2- and 3-year-old children. Pediatrics 86:197-203. McGarvey C, McDonnell M, Hamilton K, O’Regan M, and Matthews T. 2006. An 8 year study of risk factors for SIDS: bed-sharing versus non-bed-sharing. Arch Dis Child 91:318-323. McKenna J, Thoman E, Anders T, Sadeh A, Schechtman V, and Glotzbach S. 1993. Infant–parent co-sleeping in evolutionary perspective: implications for understanding infant sleep development and the Sudden Infant Death Syndrome (SIDS). Sleep 16:263-282. McKenna JJ, Ball HL, and Gettler LT. 2007. Mother-infant co-sleeping, breastfeeding and sudden infant death syndrome (SIDS): What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Yearbook of Physical Anthropology 50 133-161. McKenna JJ, and McDade TW. 2005. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breastfeeding. Paediatric Respiratory Reviews 6:134-152.

McKenna JJ, and Mosko S. 1994. Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine. Acta Paediatr Suppl 297:94-102. Messmer RL. 2009. The relationship between parent-infant bed-sharing and marital satisfaction for mothers of infants aged 6-12 months [Master of Arts]. Vancouver: The University of British Columbia. Mosenkis J. 1998. The effects of childhood cosleeping on later life development. [Master of Arts]: University of Chicago. Mosko S, Richard C, and McKenna J. 1996. Infant sleep architecture during bedsharing and possible implications for SIDS. Sleep 19:677-684. Mosko S, Richard C, and McKenna J. 1997a. Infant arousals during mother-infant bed sharing: implications for infant sleep and sudden infant death syndrome research. Pediatrics 100:841-849. Mosko S, Richard C, and McKenna J. 1997b. Maternal sleep and arousals during bedsharing with infants. Sleep 20(2):142-150. Ramos KD, and Youngclarke DM. 2003. Intentional versus reactive co-sleeping. Sleep Research Online 5:141-147. Richard CA, Mosko SS, and McKenna JJ. 1998. Apnea and periodic breathing in bed-sharing and solitary sleeping infants. Journal of Applied Physiology 84(4):1374-1380.

Reducing Infant Mortality Improving the Health of Babies

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Scheers N, Rutherford G, and Kemp J. 2003. Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations. Pediatrics 112(4):883-889. Tappin D, Ecob R, and H B. 2005. Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. J Pediatr 147:32-37. Touchette E, Petit D, Paquet J, Boivin M, Japel C, Tremblay RE, and Montplaisir JY. 2005. Factors associated with fragmented sleep at night across early childhood. Arch Pediatr Adolesc Med 159(3):242-249. UNICEF. 2008. Sharing a bed with your baby: A guide for breastfeeding mothers. Vennemann M, Bajanowski T, Jorch G, and Mitchell E. 2009. Does breastfeeding reduce the Risk of Sudden Infant Death Syndrome? Pediatrics 123:e406-410. Waynforth D. 2007. The influence of parent–infant cosleeping, nursing, and childcare on cortisol and SIgA immunity in a sample of British children. Dev Psychobiol 49:640-648. Wiley A. 2008. Cows milk consumption and health: An evolutionary perspective. In: Trevathan W, Smith E, and McKenna J, editors. Evolutionary Medicine and Health; New Perspectives. New York: Oxford. p 116-133. Willinger M, Ko C, Hoffman H, Kessler R, and Corman M. 2003. Trends in infant bed sharing in the United States, 1993–2000. Arch Pedatric Adolesc Med 157:43-49.

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Feature Story

Birth As I Know It— A Doula’s Journey on Maui By Anne Ferrier Crook, BA, CD(DONA)

Birth is the

integration of body, mind and spirit

moving us to let go and expand into our wholeness

I

arrived in Hawaii with a unique and wide range of skills in my professional repertoire. Even amidst my charmed wanderlust, I was filled with all sorts of fear, suddenly tossed into the great abyss of the unknown, not quite sure of my landing. Little did I know that Maui would continue to reveal herself in magical ways to me as I trusted that a deeper meaning and understanding in my life would be revealed to me. Several months later, I woke up to what this purpose is: birth, rebirth and what I like to call, Birth As I Know It. I began to see that my passion for birth is not only a profession, but an awakening to the deeper meaning of birth in my body, mind and spirit—a profound transformation of energy that has moved through me on all levels. Maui has been known to embody the divine feminine and the nurturing warmth

Author sitting in the ocean

of a loving womb. Each time I floated in the ocean it reminded me of being in amniotic fluid, swimming freely in the water and knowing the bliss of coming home in my body. Now this is birth as I know it! It is no coincidence that I was led to the pioneering work of Rebecca Goff’s Aquacranial Therapy, which integrates a unique blend of cranial sacral treatments in conjunction with the healing vibrations of whales and dolphins. As the gentle movements of the ocean mimic the womb, these vibrations in the water facilitate emotional release and create a profound sense of well-being.

Mana Traditional cultures have known for thousands of years that water carries life force energy. Mana, as Hawaiians call it, is of the divine. These cultures have practiced using water in healing ceremonies around the world. This spiritual bathing blends floral remedies infused with prayers to renew the spirit and cleanse the mind and body of impurities. In amniotic fluid, water is where life begins. When we find the courage to truly birth from within, we find the courage to heal and, as a result, become divine instruments of healing for the world around us. Breath is another major carrier of life force energy, the mana that nourishes our spirit. I was led to the heartfelt presence of Nina Cherry, Rebirthing Facilitator and Life Coach. Tuning into the breath and learning to channel its powerful healing properties throughout the body, mind and spirit, has proven to be a gentle and effective way to release stored emotions and unconscious beliefs from the tissues. Breath, like water, represents continued on page 26

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Feature Story

A Father’s Perspective on Doulas By Austin Hnath

K

atie and I had just gotten over the initial excitement of her pregnancy and were beginning to focus on the game plan for birth when she said, “I’m worried about the birth.” I responded, “It’s going to go well and Emme will be great.” She countered with, “No, I’m worried about me.” I didn’t know what to say. I realized that birth is one hundred percent focused on the baby, but now wondered as did Katie, “What about mom?” This was a real eye opener for me. In actuality mom is fifty percent of the birth! Although we had a close relationship, I doubted my ability to take care of her during the intensity of birth. Katie asked if we could look into a doula. I unsuccessfully racked my brain of all the new pregnancy and birth terminology I recently learned and admitted not knowing what this was. She said, “It’s someone who takes care of me and focuses on me during birth.” What a great idea! I got excited as I researched the doula field. We picked a doula with whom we felt a good connection and began our relationship with Jane. It is a relationship because of the trust, bond and dependency that we were going to have with her and need from her during the birth. It was important for us to feel comfortable with Jane knowing that we would be counting on her during one of the most intense and potentially vulnerable times in our lives. As Jane outlined her services, I was surprised that I never had heard of this field because it made so much sense. Jane armed me with knowledge on the birthing process and how I could maximize support for my wife; a truly awesome learning experience. I felt calmer and confident that I would be able to provide great support to Katie and help her through birth. I had always wanted to be involved in the birth process and Jane was going to help me be fully involved.

Using a doula was one of the

best decisions I have ever made

The big day came and Katie and I were ready! With Jane’s help we had a plan and were confident and at ease. The time to put our new knowledge to work was upon us. As the pain and discomfort started to ascend onto Katie, I had a quick moment of panic, which was very quickly replaced with a sense of overwhelming calmness. Jane and I instinctively jumped into action. Whether it was applying compresses, massaging or whispering reinforcing words, Jane and I worked masterfully together and at times read each other’s minds as to what Katie needed. A mere two hours and three pushes later, baby Emme was born. Moments after Emme’s birth it became clear that all the classes attended and reading we had done did not prepare us for the real life thing! We learned that Jane had more talents than just helping my wife with labor and birth. Katie and I quickly agreed to have her help us in the early postpartum weeks. Jane was wonderful! She talked to Katie about all the emotions she had as a new mom, helped her process her fast labor and explained what to expect from a newborn. Katie has many close friends, but none of them knew the intimacy of her labor. Jane was able to help Katie on so many different levels. Everyone talks about birth plans and how and where they are going to give birth. I rarely hear anyone

talk about the reality of having a newborn. Having a postpartum doula was just as important for us as having a birth doula. Jane was able to assist around the house and help us care for the baby and Katie as she healed. This allowed me as a new father to really be in the moment with my new family knowing that Jane was keeping the house going and would be there to answer any questions or concerns. To be able to comfort and take care of Katie the way I did with the support of a person dedicated to her well-being has led me to realize that using a doula was one of the best decisions I have ever made. I love that I was so involved in the birth of my daughter and Katie and I love sharing the experience with others. My chest pops out a little bit and I get this, “Yeah, I’m the best husband and dad” smirk on my face when they are impressed. Unfortunately I find it easier to talk about this with women than with men, but I hope that someday it will be the standard for men and doulas to mother the mother together during the birthing process. I honestly believe that helped Katie have a successful birth and postpartum experience. Austin Hnath is the proud father to his 21 month old daughter. He is a very supportive and educated husband and father who values and respects the power of childbirth. Austin is an advocate of doulas and hopes to bring awareness to other fathers.

www.DONA.org 15

Feature Story

The Lullaby of Love By Marie Bigelow, MT-BC, CD(DONA)

I

have always seen myself as the perfect mix of my parents. My mother was a musician and my father was a family scientist. They both were teachers at a local college and I spent my formative years admiring each of them dearly. As an adult, I found myself pulled between my desire to make music and my desire to serve families. I received a bachelor’s degree in Music Therapy from Utah State University and also became a certified birth doula. I quickly found that my love of music beautifully harmonized with my doula work as I began writing lullabies with my doula clients and with the couples in my childbirth education classes. Aside from the obvious warm and fuzzy feelings a lullaby provides, lullaby composition prepares parents and babies in many ways for their new life together. © © © © © ©

Paternal involvement In today’s busy world, there is little time for fathers to be involved in many of the prebaby productivity. Decorating the nursery, picking out clothing and stocking up on diapers are things that most mothers do themselves and typically enjoy. Fathers need to take time to think about and prepare for the baby, too. While the task of music writing may be disenchanting, sometimes the most reluctant father becomes the most opinionated about lyrics or melody. It is incredibly rewarding to see a soon-to-be father come out of his

comfort shell and really start to share his feelings about his child with his partner through the music.

Expression Throughout the history of time, man has always turned to music when words just weren’t enough. Music stirs our emotions and touches our hearts. It helps us say what we feel inside when we do not have the appropriate words and is an ideal medium to express the love a parent feels for a child. Writing a lullaby provides parents with this unique opportunity.

_Š }{Š‰ |wŠ~{ˆ‰ „Œ…‚Œ{z „ xwx preparation. _Š ‰ w yˆ{wŠŒ{ …‹Š‚{Š |…ˆ y…‹†‚{‰ Š… ‹‰{ to express their love to their unborn child. _Š ‰ w x…„z„} {Ž†{ˆ{„y{ x{Š{{„ the couple. _Š †ˆ…ƒ…Š{‰ †ˆ{„wŠw‚ x…„z„}D j~{ ‚‹‚‚wx Š‰{‚| y…ƒ|…ˆŠ‰ w„z ˆ{‚wŽ{‰ the newborn. W|Š{ˆ xˆŠ~B Š~{ ‚‹‚‚wx ‰ ‹‰{z Š… soothe the infant.

Since sound is the only sense that is the same inside and outside of the womb, it is a powerful avenue to use directly after birth 16 International Doula

Volume 18, Issue 1

Humans often want to take the love they have inside and make something tangible with that emotion. Creating a family with someone is an example of this concept. Lullaby writing takes that parental love and turns it into something that is not only musical but tangible, which the child can cherish his/her entire life. It gives the parents a creative, yet concrete, way to share their love for their child on a daily basis.

Couple bonding By uniting together to write a lullaby, the couple strengthens their own relationship. Their emotions are heightened through the music and they are brought closer together through their shared love for the child. Working together to create something beautiful cannot help but bring people together!

Prenatal bonding Once the lullaby is completed, I encourage both parents to sing it to their child on a daily basis to promote prenatal bonding. This assures that the parents are taking time from their busy days to quietly love and bond with their child through song. Lullabies are found in all cultures of the world and are a vastly important part of early parenthood and human nature. Studies have also shown a rise in the hormone oxytocin when lullabies are sung prenatally. Parents can even train their bodies to produce elevated levels of oxytocin when the lullaby is sung.

Comforting the newborn Since sound is the only sense that is the same inside and outside of the womb, it is a powerful avenue to use directly after birth. When the lullaby is used during the pregnancy, the child will recognize it after

birth. This will help the newborn orientate to his/her new environment and find that secure base in the voice of his/her parents. It is a magical moment when mother, father and baby are together for the first time in the outside world. The lullaby creates the perfect environment to welcome their new child. It should be sung often the first few days after birth. Several of my clients had babies in the NICU and found the lullaby to be a great comfort to themselves and their child in that often stressful setting.

Soothing the infant It is up to the family how to use the lullaby after birth. Some new mothers enjoy singing it (often along with other songs) while nursing. Other parents use it only at nap and bedtime as a signal that it is time to get drowsy. When used consistently, even the most active child will be soothed and settled down by their lullaby. My oldest is now almost five years old and still enjoys when I sing her lullaby to her. When she doesn’t want to go to bed and I start singing her lullaby she will yelp, “I don’t want you to sing my lullaby that will make me tired!” “Exactly,” I think! Some parents choose to use the lullaby any time the child is upset and needs soothing. There is no right or wrong way to use a lullaby. Lullabies carry a high success rate of soothing children with no risky side effects (unless it upsets your five year old). I recently received an e-mail from a past client, expressing her love of the lullaby she and her husband wrote for their now one year old. It said:

calm her down. If and when we have a second child I will want to take the Music Birth class again because I want my second child to have a lullaby all his/her own!

Conclusion Since lullabies are found in every culture, one can conclude that they work; but in North American culture we are often hesitant to sing. It is important to encourage the couples we work with to sing to their children so that they and their offspring do not miss out on the wonderful benefits lullaby singing can bring into their home. If you or the couple you are working with do not have the musical skills to compose a new lullaby, help them alter the words of an existing lullaby. Lack of ability should never prevent a couple from creating their own lullaby of love. Marie Bigelow graduated magna cum laude from Utah State University with a degree in Music Therapy. After graduation, she spent a year specializing in Music Therapy Assisted Childbirth. She has been a DONA certified birth doula for four years. She teaches Music Birth Childbirth Education classes at a hospital in Boise and serves doula clients in the Boise, ID area.

I wanted to thank you again for the Music Birth class, especially the lullaby we wrote together for our babies. I sing it to A everyday. I even made up some more verses to it. It is just so special to me and to A. Sometimes it seems to be the only thing that will www.DONA.org 17

Feature Story

Read THIS, Not That By Nicole Deelah

I

am sure that many of you have heard of the international bestseller, Eat This, Not That, by David Zinczenko and Matt Goulding. That book got me to thinking. There are so many options in pregnancy and childbirth preparation literature; a newly pregnant parent can become lost in the plethora of pages. Because of that, I began sifting through my library and categorizing my books. For every mainstream publication that I would not recommend to a pregnant woman, I made sure to have three alternate options. This worked its way into a Read This, Not That book list that I now have posted in my library. Each bypass provides an explanation of why I would not recommend it followed by three alternative selections. These alternatives are broken down into subcategories: © © ©

CITIZEN (for the average woman, safe to give at a baby shower without offending) SEEKER (for the woman who is definitely looking into her options but not sure what she wants) SOLD (for the woman who knows what she wants, has done the research and is a proactive consumer)

Bypass: What to Expect When You Are Expecting by Heidi Murkoff and Sharon Mazel. While learning to crawl, my second-born found and proceeded to rip every page out of my copy of this book. Filled with common scare tactics and medical promotions, I find so many women turn into anxious balls of nervous wreckage after reading this book. Although it contains a lot of relevant 18 International Doula

educational material, it is delivered in such a way that women are not brought into that knowledge in an empowering and positive way. Instead, it leads women to believe that there are so many cautions, tests, deviations and alternatives that something is bound to happen! Empower and educate it does not. INSTEAD READ: CITIZEN: Conception, Pregnancy, and Birth by Miriam Stoppard. This easy to read walk-through covers everything from ovulation to breastfeeding. Filled with beautiful photographs and illustrations, it is user-friendly and educational. She treats pregnancy as beautiful, normal and natural and allows women to look at their bodies in awe. The sections on birth provide step-bystep information on the stages of labor as well as coping techniques, positions and possible interventions. SEEKER: Pregnancy, Childbirth, and the Newborn by Penny Simkin, Janet Whalley and Ann Keppler. This is a much more thorough and in-depth educational piece than its counterpart above. It deals much more with variations, interventions, medications and the like while also continuing to provide this information in a non-threatening, non-frightening light. It remains factual without becoming intimidating or sentimental. Some key components that make this a great book are the role of the birth partner, charts on interventions, risks, benefits and emotional and physical landmarks of pregnancy, labor, birth and postpartum.

Volume 18, Issue 1

SOLD: Having a Baby, Naturally by Peggy O’Mara, Jackie Facciolo and Wendy Ponte. This book is similar to the two above without the illustrations and photographs of the first and without the non-biased viewpoint of the second, explaining in detail their slant and reasoning for natural. This book is a great companion for homebirth mothers. In particular, I love that they devote a full section to the expectant father. This is a great resource for natural pregnancy, birth and parenting, but only for those who are already set on that path. Bypass: Planning for Pregnancy, Birth and Beyond by the American College of Obstetricians and Gynecologists. Basic and boring! Those are the two key words I can come up with for this particular book. It includes advice on a lot of good topics, but the delivery is typical and very intervention friendly. It is written like a text book and is not easily used as a reference. This one definitely presents the model of pregnancy as a medical condition. INSTEAD READ: CITIZEN: The Pregnancy Book by William Sears, Martha Sears and Linda Hughey Holt. This book is an easy read, never talking over their audience, but providing practical,

fun, medical and optional information in a month-by-month setting. All in all, it is a fairly good pregnancy guide. SEEKER: The Thinking Woman’s Guide to a Better Birth by Henci Goer and Rhonda Wheeler. A very in-depth look at interventions, medications and birth, as well as a hard look at the obstetrical system. This book dissects the medical research to give sound, well-rounded information. It can be hard to digest, but it arms women with an arsenal of information to make informed decisions on just about everything they might encounter during labor and birth. SOLD: Gentle Birth, Gentle Mothering by Dr. Sarah J Buckley. This book is fully balanced with information on intuitive, as well as evidence-based birthing and parenting practices. It takes the best of maternal/ ancestral wisdom and medical/research wisdom and combines the two to give an insightful look into gentle birth and gentle mothering. Bypass: Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth by William Camann and Kathryn Alexander. Although the authors give wellrounded information on both the medical and non-medical means of pain relief for labor and birth,

there is a bit of an overplay on how painful labor and birth is - revisiting the idea of pain repeatedly and over-sensationalizing it. It minimizes the risks and side effects of epidurals, while also negating the effectiveness of alternate comfort measures; which, as a result, champions medical pain relief options. INSTEAD READ: CITIZEN: Your Best Birth by Ricki Lake, Abby Epstein, and Jacques Moritz. This new book gives great advice about options in a non-biased, non-confrontational

way. It presents all concepts of labor and birth, including how to choose a doctor or midwife and birthplace, write a birth plan and become a proactive healthcare consumer. It is not as in-depth as some of the other books but it definitely gets women thinking SEEKER: The Birth Book by William Sears and Martha Sears. The good, the bad, the ugly and the best—all in a very readable format without the scare tactics. This book presents the options as well as the risks and benefits of each without

A newly pregnant parent can become

lost in the plethora of pages

www.DONA.org 19

Feature Story sugar coating them. There is adequate information on various childbirth options and plenty of birth stories to peruse. It helps women to become educated without having an obvious bias, treating them as individual, proactive healthcare consumers. SOLD: Birthing From Within by Pam England and Rob Horowitz. This book outlines childbirth preparation by means of discovery; viewing childbirth as a journey and an opportunity to tap into a new woman—the mother. It teaches that, through self discovery, letting go of birth baggage and learning about the emotional journey of childbirth, a woman can have a truly fulfilling birth experience. Bypass: The Best Birth: Your Guide to the Safest, Healthiest, and Most Satisfying Labor and Delivery by Sarah McMoyler and Armin Brott. I cannot find one good thing to say about this book. It is extremely post-modernistic while idolizing the medical community. It seeks to undermine the assistance of a doula or other childbirth professional, with an entire section focused on not recommending doulas, calling them trendy. The book teaches that childbirth methods (goals, plans, preparation) only lead to guilt and lost vision of the real goal: a healthy mom and baby. Though everyone agrees with the end goal, our path to get there is completely different.

20 International Doula

INSTEAD READ: CITIZEN: The Official Lamaze Guide by Judith Lothian and Charlotte DeVries. Written in a similar vein to Natural Childbirth The Bradley Way, this book differs in that it focuses a great deal on allowing birth to unfold naturally. It provides encouragement for normal labor, knowledge on what can disrupt it, Lamaze coping techniques and how to assimilate personal strengths and traits into the birthing room. SEEKER: Natural Childbirth The Bradley Way by Susan McCutcheon-Rosegg, Erick Ingraham, and Robert A. Bradley. Some consider this book a childbirth preparation class without the classroom. It outlines the rationale for natural birth, the anatomy and physiology of pregnancy, labor and birth and the emotional as well as physical signposts of labor and birth. It teaches a number of relaxation techniques and positions for labor and birth, all while encouraging partners to be active participants and assistants. SOLD: Ina May’s Guide To Childbirth by Ina May Gaskin. This book challenges the cultural assumption that childbirth is a medical, frightening and painful experience by providing a whole section of amazing birth stories that turn any preconceived notions on their heads. In addition, it provides honest, effective and logical instruction on ways to help progress and assist in the birth process, without getting methodical.

Volume 18, Issue 1

I have other great reads, as must you. When we know our clients and what they are hoping to achieve, we can recommend the best books for them, while steering them away from those that will not support, encourage and affirm them on their birth and parenting journey. Editor’s Note: The opinions expressed in this article are those of the author. Nicole Deelah is an independent childbirth educator and doula in the Grand Rapids, Michigan area. Having been active in the childbirth community for over ten years, she promotes education, self-confidence and woman-to-woman support for better births and parenting. She has five children of her own, a wonderfully supportive husband and aspires to become a midwife in the near future.

TRICKS OF THE TRADE

Meet the (Backup) Doula By Jill Simon-Sinclair, B.A., B.Ed., CD(DONA)

T

hose in the doula community recognize that birth is an unpredictable thing. You just never know when a baby will come and what will be happening in your life at that moment. As much as we doulas want to be present for each and every client’s birth, there will likely come a time when that just cannot happen. Illness, childcare issues, another birth… there are a lot of reasons why we might not make it to a birth. I was particularly aware of this possibility when I started my career as a doula because my own doula had been unable to attend my birth. I was disappointed that she could not be there, even though she had a good reason and provided a backup doula. With this experience fresh in my mind, when I started taking clients I decided that I would try to do anything I could to make it to every one of my client’s births to avoid them feeling that same disappointment. I decided to take only one birth per month and to take clients with due dates that were four weeks apart. I also made some great connections with other doulas and worked out backup arrangements, just in case. I naively thought that if I planned and prepared well enough I would never miss a birth. In my sixth month of working as a doula my theory was proven wrong; one overdue birth collided with an early arrival and the thing I most wanted to avoid was happening. I had to miss a birth. I was grateful that one of my backup doulas could be there, but my client was disappointed and she let me know it. While this was very hard to hear, it reminded me that this possibility would always be a part of every doula’s career. After all, I had done everything to prevent it and it happened anyway! I am no longer afraid to miss a birth. I am only human. I cannot guarantee my clients that I will be able to make it to every birth, but I can prepare them for this possibility long before it happens and ensure a seamless transition to an excellent backup doula. It has been a hard and humbling lesson, but it has been just one of many learned in this amazing life as a doula. Jill Simon-Sinclair is a DONA certified birth doula working in Vancouver, British Columbia and in Belgium. She is also a member of the DONA International Development Committee. Jill teaches prenatal classes and provides breastfeeding counselling. Her proudest moments came at the births of her children, Sophie and Evan.

Tips for using backup doulas

* *

Form a good backup arrangement with a few other doulas who have a similar approach, personality and experience level.

* * *

Be sure to include your backup policy in your letter of agreement or contract.

*

Do not assume that accepting clients with due dates far apart will prevent two babies from being born at the same time.

Be sure that you talk to your client about the possibility of missing her birth and explain what you would do in that case. Be honest about the possibility; honest to yourself and your client.

Alert your backup(s) when you are heading to a birth to find out who would be available in case you receive a second birth call. If you have clients with close due dates, call the other client when you go to the first labour to let her know you are heading to a birth and give her your backup doula’s telephone number. (Your cell phone may not work in some areas of the hospital.)

LAMAZE MEMBERSHIP SUPPORTS DOULAS Fast-Forward Your Career with Lamaze Lamaze introduces you to the latest studies and evidence-based practices in pregnancy, birth, and early parenting——the necessary facts to help you better serve expectant women and their families.  Lamaze Workshops and Annual Conferences Absorb the bright ideas and care practices of passionate, talented birthing professionals from all over the world. A unique selection of educational sessions and discussion will develop your communication skills, helping you build relationships with new mothers in your community.  Lamaze International puts you at the forefront of the exciting world of maternity care and parenthood, uniting you with passionate minds both online and face-to-face. Become a Lamaze Member today. Visit ZZZODPD]HRUJ.

www.DONA.org 21

MULTICULTURAL ESSAY

A Doula’s Experience in

AFRICA

By Jen Serdetchnaia

M

ary prepared to go into labor with the ease of one getting ready for a doctor’s checkup. A slim-framed woman appearing to be in her late twenties, she lay on the barren blue cot of the square delivery room that, in another world, could be compared to a walk-in closet. The makeshift shutters on the window banged open and shut, periodically voiding the room of all light. There was no electricity. Mama Suzanne, the midwife, placed a wax candle between Mary’s feet to alleviate the scent, causing a shadow puppet show to perform on the walls without an audience.

-AMA 3UZANNE beside the delivery cot

Standing at Mary’s head with a plastic cross clasped between her hands was her aunt. “Sitica, sindica,” she said in the local Lusoga dialect—hush and push. Mary rode the unmedicated pangs of childbirth in silence, the only telltale sign of her body’s effort being her scrunched forehead. Mama Suzanne flicked two of her fingers below Mary’s navel to encourage the baby. This was Mary’s eighth birth. For many reasons such a birth is difficult to imagine within the borders of the United States, but is more than commonplace in rural Uganda. This past summer I volunteered as a midwife’s assistant at Mama Suzanne’s Maternity in the village of Luzinga where three to four women gave birth daily. Private rural maternities like Mama Suzanne’s are a crucial part of Uganda’s maternal care system. In a country that has the highest fertility rate in Africa, the average woman has about seven children. In some Ugandan tribes, each woman gives birth to more than fifteen children. Although the birth rate is highest in rural areas like Luzinga, it is the women living there that are least able to access and pay for the transportation that would bring them to the health centres and hospitals concentrated in cities.

Mama Suzanne’s Maternity Mama Suzanne is part of the solution to the maternity healthcare access problem in rural Uganda. Her reputation precedes her all around Luzinga as the best midwife in the area and as soon as I met her, I wanted her to attend the births of my hypothetical children. This incredible powerhouse of a woman opened up her Maternity, family and arms to me. Her actual name is Margaret, but she is known to all as Mama Suzanne by the Ugandan tradition of the woman 22 International Doula

Volume 18, Issue 1

being called by her first-born’s name. As she herself is the mother of eight, her patrons feel safe in her experienced arms. She emanates strength. Mama Suzanne’s Maternity is a private venture, which she is proud to support in part with income from her sugar cane fields and also through small contributions for her services, paid in cash or in kind. Mama Suzanne shared with me that her dream is to open a community-based Maternity where she will be able to provide completely free prenatal care and labor assistance based on securing another source of funding. It was in Mama Suzanne’s strong hands that Mary was depositing her baby Jenny. (Her name was the diminutive of mine through no coincidence—it is the custom in Uganda to name the female newborn after the presiding midwife or midwife’s assistant if it is her first time attending a birth at that location.) Minutes before the birth Mama Suzanne determined that the umbilical cord was wrapped around the infant’s neck. At the moment of birth, she acted quickly to maneuver the baby to free her from the cord. She then tied a string around the umbilical cord to prevent bleeding when it was cut. As soon as the infant was detached, she was laid on her mother’s stomach. Mary stayed at the Maternity for just four hours before walking home. Mama Suzanne told me it is common for women to head home the same day as giving birth or, at the latest, the morning after. Most mothers feel they do not need longer to recuperate, and Mama Suzanne also has extremely limited bed space. I wish I could say that all I saw last summer was beautiful, natural childbirth. I wish I could say my main experience was observing how birth is not treated as surgery. However, for better or worse, I have also seen the limits to which healthcare services are pushed and how

Ugandans strive to work with their limited resources to overcome these obstacles. In the most fertile country in Africa, life finds a way.

IN THE MOST FERTILE COUNTRY IN AFRICA,

LIFE FINDS A WAY

Jen Serdetchnaia is a student at the University of North Carolina at Chapel Hill in the field of public health. She is a trained doula with the University of North Carolina Hospitals. Jen is a freelance journalist covering issues of public health for the University of North Carolina’s Daily Tar Heel Newspaper and writing a column for the Canadian Girls Can Do Anything magazine. She spent the summer researching birth practices and family planning in Uganda and is now studying Chinese-Mandarin abroad in Xiamen, China.

#LOCKWISE FROM TOP 6ACCINATION mUID BOTTLES AT -AMA 3UZANNES -ATERNITY BEING WASHED SO THEY CAN BE REUSED POST DELIVERY ROOM -AMA 3UZANNE AT THE DOOR TO THE -ATERNITY SIGN IN FRONT OF -AMA 3UZANNES -ATERNITY !LL PHOTOS *EN 3ERDETCHNAIA

www.DONA.org 23

POSTPARTUM ESSAY

The Postpartum Doula By Katherine Hensley, PCD(DONA)

I

have always been a doula and am excited to have a name to go with the work I love. The role of the doula is so much more than anyone can imagine. I am often hired to fill in the gaps when family and friends cannot be available. Many times a doula is the first outsider to witness the family in action. Through compassion and education I am able to listen and help process the birth story and offer quiet, gentle guidance to the new mother who looks to me for relief. I assist the family to find the method of parenting that works best for them and help them adjust. I strive to ensure confidence in the mother’s intuition that she will be a great mother with the full ability to love and provide for this new child. Lastly, I am available to offer my non-medical support and referrals to the community support system already in place.

CONFIDENCE IS CONTAGIOUS All of these skills have been put to the test during my time as a postpartum doula. Recently I had the privilege of working with a new mother who was overwhelmed. The skills I learned in my workshop gave me the confidence to assist her in her recovery from birth and help her adjust to life as a mother with great elegance. Although my time with a new mother is about her journey, I believe that giving birth to four children in the past eight years has given me real life experience to draw from.

Value of postpartum doulas A value cannot be placed on empowerment or the compassionate support of gentle listening, nutritious meals, skillful hands and useful resources. Confidence is contagious. 24 International Doula

In Photo from left to right: Elliott, $AVE (USBAND %LIZABETH 2OSS Katherine Hensley and Alice-Hunter

As with life, not all births are perfect. Sometimes a family has a loss of life, loss of a dream for a healthy child, or a loss of the perfectly planned birth experience. Having my stillborn daughter at 39 weeks spoke to my heart and called me into service with families during this time. I feel passionately about the family waiting for the joy and laughter because transition after birth can be more peaceful when someone holds your hand and listens to your journey. I look forward to the day when no mother has to be alone during the fourth trimester.

Benefits of postpartum doulas In those first few weeks postpartum, getting the most informative, healing and loving foundation enhances a new mother’s confidence, stabilizes the family’s transition and helps establish healthy bonding and an overall peaceful fourth trimester. Transitioning with the new family dynamic can be as stressful for a father and siblings as it is for the new mother. Doulas are trained to be aware of the signs of compromised physical and emotional health. They model behaviors to family and friends, such as being accepting of the mother’s need to communicate her

Volume 18, Issue 1

feelings, providing practical household support so the mother can rest or tend to her baby and taking the burden off the new parents who feel as though they should be able to do everything themselves. Postpartum doulas provide personalized education about what to expect with newborn behavior, baby soothing skills and attachment parenting. In the end, a postpartum doula fills the void that society has left in the mother’s birth process and facilitates a smooth and rewarding transition from pregnancy to postpartum that benefits the whole family. It is well known that early support equals a higher success rate in breastfeeding and self-confidence, decreases postpartum depression and empowers mothers to succeed. I love my work and I am blessed that I have an outlet for my gifts. Every family can benefit from the support and companionship of a doula during the fourth trimester. Katherine Hensley, PCD(DONA) comes with her love of infants, mothers and the birth process. Born and raised in Charleston, SC, she now lives in Asheville, NC. Katherine is a postpartum doula with Peaceful Beginning Doula Services.

BIRTH ESSAY

Pre-birth Butterflies By Emmanuelle Goodier, CD(DONA)

I

just got the call. My clients are asking me to join them. I gather my bags, head to the car and start driving. As I shift into gear, thousands of butterflies suddenly flutter in my stomach. My thoughts churn them at high speeds. How will this birth go? How will the mother cope? Will I do a good job? Can I really help this family during labour? What if I make a misstep? What if I forget? What if something happens during the birth? As I catch the waves of my thoughts, I remember to breathe, slow and deep. Over and over again I breathe as I try to calm my thoughts and bring the butterflies to rest. I remind myself to trust birth and that all will be well.

Expectations

COULD THE

BUTTERFLIES’ PRESENCE BE MY MIND’S WAY TO MAKE SURE I AM PREPARED AND READY FOR THE BIRTH?

With each birth that I attend, the pre-birth jitters come. It leads me to wonder if all doulas, regardless of experience, feel the same on their way to a birth. When I think about it, I wonder if that bit of nervousness is related to confidence. Could it be that I am still relatively new to doula work and that I have not yet developed the confidence in myself and in my skills as a doula? I am not quite convinced that this is the answer. Could the butterflies’ presence be my mind’s way to make sure I am prepared and ready for the birth? My thoughts lead me to consider different scenarios and how I would deal with those situations. The nervous energy forces me to focus on the work I am about to do. Maybe the butterflies reflect a worry about not letting my clients down. My clients’ trust in my ability to help them in labour is an honour that comes with expectations. I do worry about meeting those expectations, but at the same time, I also know that all I need to do is smile to help make birth more positive for this couple.

Only natural What the jitters comes down to, I think, is a genuine response to a boost of adrenaline mixed with a dose of caring. When you care about the work that you do wholeheartedly, when you are passionate about your job, when you feel privileged to be invited to one of life’s most miraculous events, it is only natural to feel a little nervous. In that respect, the flurry of butterflies is a good thing. It keeps us in awe, it propels us to do our best and most important, it shows that we care about the work that we do. As a friend and colleague of mine says, the day when we go to a birth without butterflies in our stomach will be the day when we have become jaded about birth and our work as doulas. I don’t know about you, but I hope this day never comes. In the meantime, as I drive to each birth and feel the butterflies in my stomach, I feel grateful for being a doula. I also know that when I get to the birth, I will feel peace and confidence. I know I will do my very best to help support the couple. I trust that all will unfold as it should. I trust that my clients will make the best decisions they can. I know that I will leave feeling elated, happy and over the moon. Emmanuelle Goodier is a DONA certified birth doula living in Ottawa, Ontario who also teaches childbirth preparation classes and is hoping to become Lamaze certified soon. She is grateful to have a supportive husband and three children, two of which were born with a doula holding their Mom’s hand.

www.DONA.org 25

Feature Story Birth As I Know It continued from page 14

life in its unique form and symbolizes our connection to the divine. I realize my passion for birth is my passion to heal. I am birthing out of fear and into love. Through this transition, the ocean becomes my metaphor. It is the sacred womb, calling me back to the divine and renewing my spirit. As I find the courage to step into the unknown, I begin letting go and surrender to this knowingness. In reverence to the divine spirit, I write a new script. “I vibrate love. ” It is this awareness that has allowed me to trust that, however birth shows up in our lives, it is divinely orchestrated.

Pain into purpose From top: Aquacranial session with Rebecca Goff, her assistant, a pregnant women, and author; author holding a red blooming flower

While giving birth to a child may be the ultimate expression in a woman’s life, I realized through my journey that there is a common thread that becomes the

Midwifery Workshops at The Farm Midwifery Center with Ina May Gaskin and partners Midwife Assistant Workshops 0DUFK‡$SULO 0D\‡-XQH $XJ‡6HSW

Neonatal Resuscitation - $SULO

Advanced Workshops ‡ Common Sense and Tradition: Workshop for Midwives May 23-27, 2010

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‡,97KHUDS\:RUNVKRS August 28-29, 2010 CEUs awarded for all advanced workshops

Herb Workshop

May 19-22, 2010

ACNM CEUs awarded

silver lining. It is when we are stripped to our rawness that out of this moment of despair springs forth new life, turning pain into purpose. Whether this pain takes form through the stages of labor or some other means, birth is an awakening to this purpose. Birth is the integration of body, mind and spirit moving us to let go and expand into our wholeness. It is reawakening to our purpose and how we choose to utilize our talents so that we can be in service to the world around us. It teaches us how to surrender to the divine and live through this spirit of love. Suddenly, it becomes clear. I am a birth professional in every sense of the word. Whether assisting as a doula or supporting others in their healing from within, this is my joyful expression to the world. Five days before my departure from Maui, I had a dream about the dolphins. That morning I went down to the ocean and there they were. After eight months on the island I had my first real encounter in one of the most healing places on the planet. Looking back, I know that was a sign as, once again, I was stepping into the great abyss of the unknown. I heard these words echoed in my heart at the cusp of embarking on my next chapter. Trust healing. Trust love. Stepping back into the rhythms of the mainland, I know that water and breath will continue to play a significant role in the services I provide. They are sacred; they are where life begins. Yes, the purpose certainly arrived. It arrived on Hawaii Time. Anne is a DONA certified birth doula, a member of the DONA International Development Committee and a health educator. She worked in two hospital-based doula programs in Denver, Colorado, as case manager in a teen pregnancy program and as a Spanish healthcare interpreter in clinics and hospitals throughout Oregon, Colorado and Tennessee. Anne is currently creating a women’s health business called, “Integrative Birthing.” Contact Anne at [email protected].

For more information and curriculum, write:

The Farm Midwifery Workshops P.O. Box 217

Summertown, TN 38483 e-mail: [email protected] www.midwiferyworkshops.org 26 International Doula

Volume 18, Issue 1

Acknowledgements Clarissa Koenig, Photographer, specializing in maternity, www.writinginlight.com; Rebecca Goff, Aquacranial Therapist, Author, www.aquacranial.com; Nina Cherry, Life Coach, Hakomi Therapist, Rebirthing Facilitator, www.ninacherry.com

MEMBER NEWS

Postcard from Home If your membership with DONA International is through a group, it is important that you know your membership expiration date and your group representative’s name. The initial reminder for the group membership renewal goes only to the group representative, so be sure to keep in touch with this person to guarantee that your membership does not lapse. If your membership does lapse it will directly affect your certification, and you may be assessed a late fee. Plus, if your membership expires, you will no longer be included on our referral list for potential clients. You can find your membership expiration date on the back of this and every great issue of the International Doula. For more information regarding group membership, please visit the DONA International web site at www.DONA.org, or call the Home Office and we will be happy to assist you. As always, we at the Home Office are eager to serve you, our members. Please let us know what we can do for you. Sincerely,

Kathy, Angela, Terry, Amy

International Doula is a quarterly publication of DONA International, a NONPROlT ORGANIZATION registered in the state of Indiana. All rights to the content of this publication are reserved. © DONA International 2010. Articles published in International Doula do not necessarily represent the opinions of DONA International. Authors are responsible for the accuracy of all content. The names of people mentioned in International Doula are fictitious or appear with permission. Nonmembers may receive the International Doula FOR  53 DONATION )N THE interest of education and the dissemination of current and correct information, reproduction, in part or in whole, of individual articles within this publication, is encouraged unless otherwise indicated. Reproduced articles must have proper accreditation and must not be sold. This permission to reproduce is limited to numbers less than 100 unless prior permission is obtained. -OVING 4HE POST OFlCE WILL NOT FORWARD THE International Doula MAGAZINE 3END YOUR ADDRESS CHANGES TO $/.! )NTERNATIONAL 0/ "OX  *ASPER ).  OR E MAIL $OULA $/.!ORG Author inquiries should be addressed to the Editor AT )$%DITOR $/.!ORG OR MAILED TO 0/ "OX  *ASPER ).  5NSOLICITED MANUSCRIPTS ARE welcome but will not be returned.

Departed Doula DONA International would like to recognize a member who passed away within the last year.

Karen Kilson Sandy Hook, CT

Karen Kilson, a leader in the Connecticut and on-line doula communities, died on October 4, 2009. Karen was a childbirth educator and DONA certified birth doula.

Has a member of your DONA doula community passed away recently? Please let us know so that we may remember them during the DONA International Annual Conference. An acknowledgement will also be made in the first issue of the International Doula each year. Send information to Amy L. Gilliland, M.S., CD(DONA) at [email protected].

www.DONA.org 27

POEM

Forty Weeks and a Day By Dorian Solot, CD(DONA)

“I did everything right!” you tell me, Teary with bitter disappointment. “It’s past my due date—why hasn’t my baby come?” You are doing everything right, I say. The task the universe has assigned you this week is to wait. You are waiting just right. Going into labor before your due date is not a reward for good behavior Nor is starting labor past your due date a punishment for something you did wrong. You can’t rush the dandelion to bloom earlier Or make the wind blow on a hot day Or know when the starling’s eggs will hatch. You can’t rush a baby Or predict what your body is planning But you can trust it to do exactly what is perfect for this baby. In the rest of life it’s different. The one who finishes the race first is the best. The one who graduates ahead of schedule is the smartest (or so she’d like you to think). Good people are always punctual. The early bird catches the worm, after all— But not always. Millions of women around the world With big 41, 42, even 43 week pregnant bellies Are waiting with excitement with frustration with discomfort with powerlessness with impatience to meet this person inside them. All they can do is wait. They are waiting with you. One by one, each will have her day to give birth. Not one will stay pregnant forever. Dorian Solot, CD(DONA) is a birth doula, author, and sex educator. She lives in Albany, NY, and is eager to return to attending births once her toddler daughter outgrows her urgently enthusiastic need to nurse so frequently. (She will outgrow this, right?)

28 International Doula

Volume 18, Issue 1

Ouotes “Nature, time and patience are three great physicians.” ~ H.G. Bohn “Spontaneous labor in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine—nil nocere [do no harm].” ~ G. Kloosterman “Patience, persistence and perspiration make an unbeatable combination for success.” ~ Napolean Hill

ASK PENNY | PREGÚNTELE A PENNY

Who and Where Are Tomorrow’s Leaders? By Penny Simkin, PT, CD(DONA)

Dear Penny, With so many of our “birth leaders” getting older, who will carry the torch in the future? Who will be the next leaders of the mother/baby centered maternity care movement? How are we raising them up? Emily Fontes, CD(DONA) Kirkland, WA Dear Emily, Your question is thought provoking. Who is coming along to replace the aging “birth leaders” and how will they exert their leadership in today’s culture? I have had conversations with many of my aging colleagues about tomorrow’s leaders and how we can help them find their place among the leaders of tomorrow. I am not sure I have a good answer, but I will share my thoughts with you and our readers. It is certainly true that the people who have been popular leaders, speakers, and writers for decades are aging and will inevitably slow down. (Many outstanding people come to mind, but I am reluctant to name names as I will surely leave some worthy people out.) The good news is that many other leaders are in their prime and not showing the effects of age, so we won’t “run out” of leaders in the near future! Times are changing, however, and our leadership will emerge in different ways than today’s leaders. Before thinking about the leaders of tomorrow—where they will come from and how they will lead—let’s look at where today’s aging leaders came from and how they have led. When they appeared on the scene as leaders, they were independent thinkers with a passion for birth-related issues and a talent for communicating their message. They had worked hard in their field for years before they became recognized as leaders. Their qualifications and educational backgrounds vary – physicians, midwives, anthropologists, physical therapists, nurses, childbirth educators, doulas, social workers, and others. Because they were persistent,

NEW NAMES AND FACES ARE EMERGING hard-working, and curious, they educated themselves on all aspects of pregnancy, childbirth, and maternity care, including the issues and controversies. They learned from childbearing women, and many conducted ground-breaking research. They recognized that mainstream maternity care has “missed the mark” in many ways. They saw that complete reliance and faith in technological and surgical approaches to pregnancy and birth led to neglect and ignorance of the psychological, spiritual, and physiological aspects of childbearing. Each leader had specific areas of interest and expertise and taught about those. They spread their message by publishing books and papers, speaking at conferences and holding workshops. Many have been active volunteers, donating time, expertise and hard work to birth education and reform. Most spent much time listening to and working directly with childbearing families. To them, their message is or was more important than financial success. Most were frugal

and had the good fortune to have supplemental income from other sources to help support them as they worked for little remuneration. Few birth reformers have been able to earn a decent living by following their passion. Can such a combination—of study, public and professional speaking, writing for publication, volunteering in worthy organizations, caring for childbearing families, and meager earnings—work for tomorrow’s leaders who have the same passionate commitment to birth reform? It is not likely. Workshops and conferences, as educational and inspiring as they are, are inefficient and costly ways to spread the word. Likewise, books, journals, newspapers, and other print media are on the decline as sources of information. All these are being supplemented, and to a large extent replaced, by the miraculous communication medium of the Internet. Tomorrow’s leaders will have less face-toface communication with their audiences but will reach many more people. www.DONA.org 29

ASK PENNY | PREGÚNTELE A PENNY

Today’s social conditions and financial pressures work against the independence and autonomous lifestyle enjoyed by the aging leaders. Few of today’s leaders have had nine to five jobs working for someone else while devoting time and talent to their passion. Being largely self-employed, they have had time to follow their interests and financially support their “habit” with royalties, speaker fees and services to clients. The freedom that accompanies self-employment comes with tradeoffs— dependence on other sources of income, lack of grant support, no coverage of expenses, no employee benefits, etc. These trade-offs make it impossible for many younger birth reformers to maintain such a lifestyle. The need for steady income with benefits, time for family, and other interests presents other challenges. The fact that most not-for-profit reform organizations are financially strapped means reliance on volunteers in a time when two incomes are usually necessary for a family to maintain a comfortable

DID YOU KNOW? Valuable information is gleaned from every BIRTH 9/5 ATTEND
COMPLETE A BIRTH OR POSTPARTUM DATA COLLECTION FORM for each and every EXPERIENCE 9/5 attend as a DONA trained doula and MAIL OR FAX IT TO the DONA home office:

P.O. Box 626 Jasper, IN 47547 FAX: (812) 634-1491

30 International Doula

lifestyle. The luxury of time to volunteer significantly to a cause seems to be available to relatively few people today. Those who do selflessly give their spare time to this movement often get tired, stressed, and burned out after some years of sacrifice. The key and the challenge for the new leaders of today and tomorrow are to generate sufficient living income while pondering the larger questions, developing ideas and new perspectives, and having forums to discuss and exchange ideas. The savior for childbirth reform is likely to be the Internet! Social networking and use of the Web for teaching and communication are effective ways for new leaders to become known and exert influence without having to travel so much to speak at conferences or give workshops and write entire books. New names and faces are emerging, especially those representing the many childbirth reform organizations – Childbirth Connection, the Coalition for Improvement of Maternity Services (CIMS), Baby-Friendly USA (also in other countries), and the numerous organizations supporting or representing midwives, doulas, lactation consultants, family physicians, childbirth educators, and the childbearing public—which are breeding grounds for tomorrow’s leaders. I see no dearth in capable, dedicated, hardworking, creative thinkers and doers who will devote their talents and leadership qualities to the improvement of maternity care. They will exert influence in contemporary ways—and become familiar figures to Internet surfers, webinar attendees, Facebook and Twitter users, YouTube viewers, and more. Discussion groups, blogs, web sites, e-newsletters, Internet surveys, and massive search engines provide tools and visibility to the savvy leaders of tomorrow. While the style of leadership will change, tomorrow’s leaders will work for the same goals that today’s leaders have strived for over the past sixty years—safe, evidence-based, woman- and familycentered maternity care, education, and support that is based on mutual respect between caregivers and clients, informed, shared decision-making, and freedom

Volume 18, Issue 1

from special interests and excessive medicalization, and restrictions on accessibility. Of course, we are already seeing much of this happening, and the new leaders are already emerging. And our present leaders will try to adapt to the new ways, but will also continue to work in the ways they know best for better maternity care—midwifery, doula care, and childbirth education, safe options for birth inside and outside the hospital, lactation support, mental health services for childbearing women, support for parent-infant bonding—and more. As for who will be our next leaders, they are there, and we know many of them, while others will soon emerge. I would like to ask each of our readers to watch for them, and keep a list of those young and not-so-young birth reformers who are making a difference. Keep an eye on them. Learn from them, support them, and thank them. And, be sure to include yourself on that list! Thanks for your question. In the doula spirit, Penny Penny Simkin, PT, CD(DONA) has specialized in childbirth education since 1968 and is one of DONA International’s founders. Her practice consists of childbirth education, birth counseling and labor support, combined with a busy schedule of conferences and workshops. Penny and her husband Peter have four grown children, eight grandchildren and a pug.

Please e-mail your questions for Penny to [email protected] with “Ask Penny” in the subject line.

¿Donde estan y quienes son los lideres del mañana? Por Penny Simkin, CD(DONA)

Querida Penny, Con tantos de nuestros “líderes de partos” envejeciendo, quien va a llevar la antorcha en el futuro? ¿Quienes serán los los próximos líderes en el movimiento de madres/bebés y la maternidad? ¿Cómo los estamos preparando? Emily Fontes, CD(DONA) Kirkland, WA Querida Emily, Tu pregunta me pone a pensar. ¿Quién viene a reemplazar los “líderes de parto” que están envejeciendo y cómo van ellos a ejercer ese liderato en nuestra presente cultura? Yo he tenido conversaciones con muchos de mis colegas sobre los líderes del mañana. No estoy segura si tengo una buena respuesta, pero voy a compartir mis pensamientos contigo y nuestros lectores. Es cierto que las personas que han sido líderes, escritores, y oradores por décadas están inevitablemente envejeciendo y trabajando con más lentitud. (Mucha gente destacada vienen a la memoria, pero no me atrevería a mencionarlos por miedo a omitir a alguien.) Lo bueno es que muchos otros líderes están en su mejor momento y no muestran señas de edad, así que no se van a terminar los líderes en el futuro cercano. Los tiempos están cambiando y nuestro liderazgo surgirá de diferentes maneras de los líderes de hoy. Antes de pensar sobre los líderes del mañana—de dónde vendrán y cómo van a dirigir, miremos a líderes de hoy que van envejeciendo, de dónde vinieron y cómo se hicieron líderes. Cuando ellos surgieron como líderes, eran pensadores independientes con una pasión sobre temas relacionados con partos y un talento para comunicar su mensaje. Trabajaron arduamente en su carrera por años antes de ser reconocidos como líderes. Sus cualidades y educación varía—médicos, parteras, antropólogos, terapistas físicos,

NUEVAS CARAS Y NUEVOS NOMBRES SURGEN enfermeras, educadores de parto, doulas, trabajadoras sociales y otros. Porque ellos fueron persistentes, curiosos, y trabajaron arduamente, se auto-educaron sobre partos y cuidado materno, incluyendo situaciones y controversias. Ellos aprendieron de las mujeres embarazadas y muchos de ellos comenzaron sus propias investigaciones. Ellos reconocieron que el principal cuidado materno había fallado de muchas maneras. Ellos pudieron ver que depender totalmente en la tecnología y la cirugía como los mejores métodos para el parto y nacimiento llevaron a descuidar e ignorar el aspecto fisiológico, psicológico y espiritual del proceso. Cada líder tenía un área específica de experiencia e interés y enseñó a otros sobre los mismos. Llevaron su mensaje publicando libros y artículos, hablando en conferencias, y llevando a cabo grupos de trabajo. Muchos han sido voluntarios, donando su tiempo, sabiduría, y ardua labor en pro de la reforma y educación de la maternidad. Muchos pasaron mucho tiempo escuchando y trabajando directamente con familias que esperaban hijos. Para estos líderes, su mensaje era más importante que su éxito financiero. Muchos tuvieron suerte de tener ingreso adicional de otras empresas para mantenerse mientras trabajaban por muy poco dinero. Muy pocos reformistas de parto han podido ganar su sustento siguiendo su pasión. Con una combinación como esta— estudiando, dictando conferencias públicas y privadas, escribiendo publicaciones, trabajando como voluntarios para nobles organizaciones, ayudando a familias teniendo hijos, y pobres salarios—¿es

trabajo para los futuros líderes que han sido igualmente apasionados y comprometidos a la reforma del parto? Probablemente no. Grupos de trabajo y conferencias, tan educacionales y de gran inspiración como son, no son eficaces y son muy costosas maneras de llevar el mensaje. De igual manera, libros, periódicos, artículos en revistas, y otro material impreso están disminuyendo como medios informativos. Todo esto es ahora suplementado de gran manera y reemplazado por los milagrosos medios de comunicación del Internet. Los líderes del mañana tendrán menos comunicaciones cara a cara con sus audiencias, pero tendrá mejor posibilidad de llegar a más personas. Las condiciones sociales y las presiones financieras actuales trabajan en contra del estilo autónomo de vida de los líderes de antes. Algunos de los líderes de la actualidad son personas que trabajan para otros mientras dedican su tiempo y talento a su pasión. Aquellos que son sus propios jefes, han tenido mejor oportunidad de mantener su “costumbre” con bonos, pagos por hablar en conferencias y servicios a sus clientes. La libertad que viene con ser su propio jefe tiene sus desventajas—dependencia en otros para recibir ingreso, falta de subvenciones financieras, no beneficios de empleados, etc. Esto hace imposible para muchos jóvenes reformistas de parto poder mantener el estilo de vida. La necesidad de un ingreso fijo con beneficios, tiempo para la familia, y otros intereses presentan otros desafíos. El hecho de que muchas entidades sin fines de lucro están cortos de fondos significa www.DONA.org 31

ASK PENNY | PREGÚNTELE A PENNY

2011 DONA International Conference Boston, MA Hyatt Regency

Watch for Details! NETWORK COMMUNICATIONS presents

AUDIO RECORDINGS of the 2009 15th Annual DONA International Conference in Atlanta, Georgia

On-line orders http://www.networkcommunications audio.com/DONA2009

32 International Doula

que dependen de voluntarios en un tiempo donde casi siempre se necesitan dos ingresos por familia para poder vivir cómodamente. El poderse dar el lujo de tener tiempo para trabajar de voluntario no es factible para muchos. Varios de los que lo hacen, se cansan, les ocasiona estrés y dejan de hacerlo después de un tiempo. La clave y el reto para los nuevos líderes de hoy y mañana es generar suficiente ingreso mientras desarrollan ideas y perspectivas y llevando a cabo reuniones regularmente para poder intercambiar ideas. La salvación para la reforma del parto y la maternidad seguramente está en la red social del Internet y el uso de las páginas de Internet como método de educación y comunicación efectivos para que los nuevos líderes puedan ser reconocidos y ejercer influencia sin tener que viajar mucho, atender conferencias, convocar grupos de trabajo y escribir libros. Nuevas caras y nuevos nombres surgen, especialmente aquellos que representan las diferentes organizaciones para la reforma del parto tales como: “Childbirth Connection,” “Coalition for Improvement of Maternity Services (CIMS),” “Baby-Friendly USA”(también en otros países), y las numerosas organizaciones que apoyan o representan comadronas, doulas, consultoras de lactancia, médicos de familia, educadoras de parto, y el público en edad de procrear—que son terreno fértil para los líderes del mañana. Yo no veo la desaparición de personas capaces, dedicadas, trabajadoras, y que dedican sus talentos y liderazgo al mejoramiento del cuidado materno. Ellos influenciarán de forma contemporánea y serán figuras familiares a los que buscan en el Internet, Facebook, Twitter, YouTube y otros. Discusiones en grupo, páginas de Internet, charlas y otros métodos de buscar información proveen las herramientas y visibilidad para los líderes del futuro. Aunque el estilo de liderazgo es diferente, los futuros líderes trabajarán por las mismas metas que los líderes que han estado trabajando por los últimos 60 años—estudios con pruebas circunstanciadas, educación centralizada

Volume 18, Issue 1

en la mujer y la familia y apoyo basado en respeto mutuo entre cliente y profesional, decisiones basadas en información compartida—libertad en relación al uso excesivo de drogas y restricción al acceso al parto natural. Por supuesto, estamos viendo ya mucho de esto sucediendo, y los nuevos líderes ya están surgiendo. Los líderes del presente tratarán de adaptarse a la nueva forma, pero también continuarán su labor en la forma que ellos crean mejor para el beneficio de la maternidad—comadronas, doulas, educadores prenatales, opciones seguras para el parto dentro o fuera del hospital, apoyo en la lactancia, servicios de salud mental para mujeres que pueden tener hijos, apoyo para el vínculo entre padres e hijos y más. En cuanto a quiénes serán nuestros próximos líderes, ellos están aquí y sabemos quienes son. Mientras que algunos surgirán luego, yo quisiera pedir a nuestros lectores que estén pendiente, y mantengan una lista de aquellos jóvenes y no tan jóvenes que están haciendo una diferencia. No los pierdan de vista, aprendan de ellos, agradézcanle y asegúrense de incluirlos ustedes en esa lista. Gracias por tu pregunta. En el espíritu de las doblas, Penny Penny Simkin, PT, CD(DONA), se ha especializado en educación prenatal desde el 1968 y es una de las fundadoras de DONA. Su práctica consiste de educación prenatal, consejería de parto y labor de parto, combinada con un muy ocupado programa de talleres de grupo. Penny y su esposo Meter tienen cuatro hijos, ocho nietos, y un perrito “pug.” Traducción por Augie Rigual, BA, CD(DONA) LCCE, CLC. Augie ofrece clases prenatales en español para dos Departamentos de Salud en Orlando, Florida, tiene grupos de apoyo para madres lactantes a través del hospital Winnie Palmer y trabaja para el hospital como educadora. Tiene cuatro hijos, y reside en Orlando, Florida.

PHOTO CONTEST

Capturing the Doula Spirit

! #ONTEST IN #ELEBRATION OF )NTERNATIONAL $OULA -ONTH -AY 

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ave you ever heard the phrase, “every picture tells a story” or the phrase, “a picture is worth a thousand words?” In celebration of International Doula Month, DONA International will honor its members, their doula spirit and the contribution they provide to maternity care by accepting photo action shots that tell your story as a birth or postpartum doula. Photos must be submitted during the month of May, which is International Doula Month. The winners will be announced in the June eDoula.

FIRST PRIZE The winning photo will be featured in the December issue of the International Doula and on the DONA International web site and the doula contestant will be awarded a free one year membership. SECOND PRIZE The second place photo will be featured on the DONA International web site and the doula contestant will be awarded a $25 gift certificate for the DONA Boutique. THIRD PRIZE The third place photo will be featured on the DONA International web site and the doula contestant will be awarded a $15 gift certificate for the DONA Boutique. SUBMISSION REQUIREMENTS © f~…Š… >‰{{ †~…Š… ‰†{y¢ywŠ…„‰ x{‚…? © Z…‹‚w=‰ „wƒ{ w„z yˆ{z{„Šw‚‰ © Z…‹‚w=‰ wzzˆ{‰‰ © Z…‹‚w=‰ zw †~…„{ „‹ƒx{ˆ © Z…‹‚w=‰ {Cƒw‚ wzzˆ{‰‰ © dwƒ{>‰? …| {wy~ †{ˆ‰…„ †~…Š…}ˆw†~{zB ‚‰Š{z |ˆ…ƒ ‚{|Š Š… ˆ}~Š © m~{„ w„z ~{ˆ{ Š~{ †yŠ‹ˆ{ w‰ Šw{„ w„z ~ …‹ Š~„ Š reflects the doula spirit © W ‰}„{z ZedW _„Š{ˆ„wŠ…„w‚ f~…Š… h{‚{w‰{ |…ˆƒ |…ˆ {wy~ person photographed, available on the web site at http://www. dona.org/publications/id.php. PHOTO SPECIFICATIONS All photographs will be accepted for consideration. However, the best quality photos for print publication are 300 dpi TIFF files or high resolution compressed JPEG files with good contrast of light and dark. Images intended for cover use must be at least 8˝x10˝ (original size, not enlarged) at 300 dpi and should be sent in their original, untouched/unaltered format. Color photographs must be in RGB color format, but they may be converted to black and white. All submissions should be sent to [email protected] by May 31, 2010.

www.DONA.org 33

Membership & Certification Become a member of DONA International today. Your membership includes such benefits as referrals; a subscription to the quarterly magazine, the International Doula; a discount on DONA International’s Annual Conference; and access to thousands of doulas around the world who support DONA International’s mission to improve the physical and emotional health of childbearing women and families. Furthermore, your membership in DONA International is the first step on the path to becoming a DONA Certified Doula. Act now and enjoy immense rewards as a member of DONA International.

MISCELLANEOUS

CERTIFICATION INFORMATION

MEMBERSHIP OPTIONS

All materials can be ordered from www.DONA.org in the DONA Boutique or complete this form and mail or fax it to the DONA International Home Office.

MEMBERSHIP FEES IN U.S. FUNDS For current fees in other countries, check the International Fee Group Index in the DONA Boutique at www.DONA.org or call the Home Office at 888-788-DONA (3662). Membership in DONA International includes a subscription to the International Doula magazine and eDoula newsletter. One Year $50.00 USD (U.S.) One Year $41.50 USD (Canada)

One Year $34.00 USD (Mexico)

Two Year $85.00 USD (U.S.) Two Year $70.50 USD (Canada)

Two Year $57.60 USD (Mexico)

Three Year $125.00 USD (U.S.) Three Year $103.75 USD (Canada)

Three Year $83.75 USD (Mexico)

GROUP MEMBERSHIP INFORMATION

I wish to receive information on the cost-saving group membership option (minimum five group members).

DOULAS—MAKING A DIFFERENCE A video collaboration by Douglas College and DONA International. New parents share how doulas made a difference to their birthing experiences. Featuring Penny Simkin, PT, Michael Klein, MD, Pauline Clare, CD(DONA). DVD: $20.00 USD member DVD: $25.00 USD non-member VHS: $10.00 USD member/non-member

CERTIFICATION PACKET IN U.S. FUNDS For current fees in other countries, check the International Fee Group Index in the DONA Boutique at www.DONA.org or call the Home Office at 888-788-DONA (3662). The Certification Packet contains all the necessary information and forms for certification. The packet must be completed within two years. (Allow 2-3 weeks for delivery.) BIRTH DOULA CERTIFICATION PACKET POSTPARTUM DOULA CERTIFICATION PACKET $35.00 USD member (U.S.) $28.00 USD member (Canada) $22.75 USD member (Mexico) $45.00 USD non-member (U.S.) $36.90 USD non-member (Canada) $29.25 USD non-member (Mexico)

INTRODUCING THE DOULA A video by Penny Simkin, PT, CD(DONA) DVD: $22.00 USD member/non-member VHS: $12.00 USD member/non-member INTERNATIONAL DOULA Quarterly magazine—one year subscription (membership includes one subscription) $15.00 USD member (additional subscription) $20.00 USD non-member

Please check the options you want above, then complete the form below. NAME ADDRESS CITY

STATE/PROVINCE

PHONE

E-MAIL ADDRESS

ZIP/POSTAL CODE

COUNTRY

I do not wish to have my name included in the DONA International rental mailing list

______ (initial here) As a term of agreement to become a member of DONA

International, which includes my choice to receive referrals, I hereby consent to abide by the DONA International Code Of Ethics and Standards of Practice. (See www.DONA.org for the Code of Ethics and Standards of Practice.) Please give my name to consumers as a (check all that apply) birth doula postpartum doula

______ (initial here) As a term of agreement to purchase a

Birth or Postpartum Doula Certification Packet, I hereby consent to abide by the DONA International Code of Ethics and Standards of Practice. (See www.DONA.org for the Code of Ethics and Standards of Practice.)

I HAVE ENCLOSED A CHECK FOR $_______________IN US FUNDS MADE PAYABLE TO DONA INTERNATIONAL CHARGE MY MC, VISA, AM EX, OR DISCOVER # NAME ON CARD

EXP. SIGNATURE

Return form and payment to: DONA International, P.O. Box 626, Jasper, IN 47547 USA; fax (812) 634-1491; or order on-line at www.DONA.org LAST UPDATED 3/09

34 International Doula

Volume 18, Issue 1

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9LWDO7RSLFV Traditional Midwifery Skills—2 full days Herb Workshop Spanish for Birth Practitioners Breech Skills Workshop Mexican Midwifery: Traditions and Techniques Fetal Life, Birth and Health First and Second Stage Difficulties Massage for Pregnancy, Birth and Postpartum

Attend a full-day class in Beginning Midwifery

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2WKHU&ODVVHV,QFOXGH Birth Is a Human Rights Issue Freedom to Practice the True Art of Midwifery Amish and Mennonite Midwifery Craniosacral Therapy for Mamas and Babies Tear Prevention Hemorrhage Twin Birth Prolonged Labor

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Discover the power of shared birth stories and the difference they can make in our lives. In The Power of Women, Sister MorningStar shows how healing words and empowering stories help women listen to their instincts and open to the baby who is ready to be born. The Power of Women is filled with compelling, enlightening and touching tales of women who have opened themselves to trust their inner knowing of life giving. These stories will lift the veils from your eyes and let you view the world in a new way. Give this book to the pregnant women you know. Help them see the power that resides within them.  0RWKHUEDE\3UHVV3DSHUEDFNSDJHV0%

Brought to Earth by Birth +DUULHWWH+DUWLJDQ

This stunning collection of black and white photographs celebrates giving birth and being born. Gaze upon these eloquent moments lived with power, courage, love and grace. Brought to Earth by Birth makes a lovely gift for a midwife or doula, for expectant or new moms, for grandmothers and for anyone who loves babies and birth.  0RWKHUEDE\3UHVV3DSHUEDFNSDJHV0%

 See excerpts from both books and learn more about Motherbaby Press motherbabypress.com

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www.DONA.org 35

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Shop for all your doula needs! Logo items Doula tools Gifts for clients or for yourself Books for certification Position papers and brochures Check out our new items

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